| NPI | 1881676203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 217210) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MD 2057656) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: DC MD045818) | |
| Enumeration Date | 2005-11-20 |
| Last Update Date | 2021-03-23 |